某三甲教学医院近十年血培养病原菌分布特征及耐药性变化  

Distribution characteristics of pathogenic bacteria in blood cultures and changes in drug resistance in a tertiary teaching hospital in the last decade

作　　者：王紫玲 陈熙元 袁欣宇 李洪春 WANG Ziling;CHEN Xiyuan;YUAN Xinyu;LI Hongchun(School of Medical Technology,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Laboratory Medicine,the Affiliated Hospital of Xuzhou University,Xuzhou,Jiangsu 221002)

机构地区：[1]徐州医科大学医学技术学院,江苏徐州221004 [2]徐州医科大学附属医院检验科,江苏徐州221002

出　　处：《徐州医科大学学报》2024年第6期453-460,共8页Journal of Xuzhou Medical University

基　　金：国家自然科学基金(82102408)。

摘　　要：目的分析某三甲教学医院近十年血培养病原菌分布特征及耐药性变化,为血流感染合理使用抗菌药物及防控提供依据。方法选取2014年1月—2023年12月徐州医科大学附属医院收治的血培养阳性患者,收集临床血液标本中分离的病原菌种类和耐药情况。对比分析2014—2018年与2019—2023年血培养主要病原菌的耐药变化趋势。结果2014—2023年血培养共检出11578株菌,其中革兰氏阳性菌6196株(53.5%),革兰氏阴性菌5382株(46.5%)。革兰氏阳性菌主要是凝固酶阴性葡萄球菌(4302株,37.2%)、金黄色葡萄球菌(704株,6.1%)、屎肠球菌(352株,3.0%)、粪肠球菌(208株,1.8%)。革兰氏阴性菌主要是大肠埃希菌(2355株,20.3%)、肺炎克雷伯菌(1095株,9.5%)、鲍曼不动杆菌(447株,3.9%)、铜绿假单胞菌(391株,3.4%)。病原菌主要分布在综合ICU(1702株,14.7%)、急诊重症监护室(ICU)(1436株,12.4%)、血液内科(1134株,9.8%)、感染性疾病科(758株,6.5%)。鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌对亚胺培南的耐药率分别是85.2%、18.2%、26.0%和4.0%,对美洛培南的耐药率分别是85.2%、12.7%、29.4%和4.0%;金黄色葡萄球菌和凝固酶阴性葡萄球菌对苯唑西林的耐药率分别为56.8%和80.4%,未发现对万古霉素耐药的葡萄球菌,粪肠球菌和屎肠球菌对万古霉素的耐药率分别为0.5%和1.1%。与2014—2018年相比,2019—2023年鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率上升,金黄色葡萄球菌对苯唑西林、肠球菌对万古霉素的耐药率下降,但差异无统计学意义(P>0.05),大肠埃希菌对亚胺培南的耐药率从5.2%下降至3.0%,差异有统计学意义(P<0.05)。结论本院血培养常见病原菌耐药形势依然严峻,应继续规范血培养标本的采集与送检,根据药敏结果选用合适的抗菌药物,促进抗菌药物的合理使用,共同遏制耐药。Objective To analyze the distribution characteristics of pathogenis bacteria in blood cultures and changes in drug resistance in a tertiary teaching hospital in the past ten years,in order to provide evidence for the rational use of antimicrobial drugs and prevention and control of bloodstream infections.Methods Blood culture-positive patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2023 were selected,and the species and drug resistance of pathogenic bacteria isolated from clinical blood specimens were collected.The trend of drug resistance changes of major pathogenic bacteria in blood cultures between 2014—2018 and 2019—2023 were compared.Results A total of 11578 strains of bacteria were detected in blood cultures from 2014—2023,where 6196 strains(53.5%)were gram-positive and 5382 strains(46.5%)were gram-negative.The gram-positive bacteria were mainly coagulase-negative staphylococci(4302 strains,37.2%)and Staphylococcus aureus(704 strains,6.1%),Enterococcus faecalis(352 strains,3.0%),and Enterococcus faecalis(208 strains,1.8%).The gram-negative bacteria were mainly Escherichia coli(2355 strains,20.3%),Klebsiella pneumoniae(1095 strains,9.5%),Acinetobacter baumannii(447 strains,3.9%),and Pseudomonas aeruginosa(391 strains,3.4%).The pathogenic bacteria were mainly distributed in the general intensive care unit(ICU)(1702 strains,14.7%),emergency ICU(1436 strains,12.4%),Department of Hematology(1134 strains,9.8%),and Department of Infectious Diseases(758 strains,6.5%).The resistance rates of Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,and Escherichia coli to imipenem were 85.2%,18.2%,26.0%and 4.0%,respectively,and their resistance rates to meropenem were 85.2%,12.7%,29.4%and 4.0%,respectively.Staphylococcus aureus and coagulase-negative staphylococci had oxacillin resistance rates of 56.8%and 80.4%,respectively,and no staphylococci were found to be vancomycin-resistant.The resistance rates of Enterococcus faecalis and Ent

关 键 词：血培养 血流感染 血培养阳性患者 病原菌 耐药性 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]